Pelvic tissue support devices

ABSTRACT

A delivery system is provided that is adapted to treat various urological pelvic disorders, such as prolapse, incontinence, and the like. The delivery system can include at least one biologic loaded or otherwise provided with a bioactive agent. The biologic can comprise any drugs, hormones or steroids, stem cells, growth factors, proteins, and/or other bioactive agents to promote cell or tissue growth for the treatment and strengthening of organ walls or tissue. The biologic is generally adapted to controllably release the agent to the surrounding tissue or organ to provide a local and targeted delivery.

RELATED APPLICATION

This application claims the benefit from International Application No.PCT/US2010/032746, which was filed on Apr. 28, 2010, which in turnsclaims priority under 35 U.S.C. §119(e) to U.S. Provisional ApplicationNo. 61/173,265, filed Apr. 28, 2009, which are both incorporated hereinby reference in their entireties.

FIELD OF THE INVENTION

The present invention relates generally to a treatment delivery systemand method and, more specifically, to local and targeted delivery usinga biologic loaded with an agent to treat prolapse, incontinence, and/orother urological disorders in males and females.

BACKGROUND OF THE INVENTION

Vaginal prolapse changes the position of the vagina, which can lead todiscomfort, urinary incontinence, and incomplete emptying of thebladder. In severe cases, vaginal prolapse conditions can even cause thevagina to become positioned outside of the body.

In a normal female body, the levator ani muscles close the pelvic floorand support the vagina. This results in little force being applied tothe fascia and ligaments that support the vagina. Increases in abdominalpressure, failure of the muscles to keep the pelvic floor closed, anddamage to ligaments and fascia can all contribute to the development ofprolapse. Because, childbirth can lessen the strength of relevantconnective tissue as well as the strength of surrounding muscles, it hasbeen implicated as causing vaginal prolapse.

However, studies have shown that a majority of prolapse cases occuryears after childbirth, suggesting that factors other than injury fromchildbirth contribute to the disease. Indeed, menopause accounts formore instances of prolapse than injury from childbirth. This trendsuggests that ovarian steroids, especially estrogen, greatly influencethe strength of pelvic floor connective tissues.

In order to treat weakening after menopause, a woman may use hormonereplacement therapy or vaginal estrogen cream. However, women aregenerally discouraged from using long-term hormone replacement therapybecause of associated health risks. Vaginal estrogen cream is thought tobe a lower-risk treatment than hormone replacement therapy or estrogenalone because vaginal estrogen cream is low-dose and has a localizedeffect. However, the vaginal estrogen cream must be manually applied bythe patient as directed, e.g., daily. Additionally, the vaginal estrogencream is messy during application and use.

Another pelvic disorder that can occur in patients is referred to asurinary incontinence or involuntary loss of urinary control, which is aproblem that afflicts men, women, and children of all ages. A variety oftreatment options for incontinence are currently available. Some ofthese include external devices, behavioral therapy (such as biofeedback,electrical stimulation, or Kegel exercises), and prosthetic devices.

Recently, crosslinked bovine collagen has been used as a bulking agentto treat incontinence with symptomatic improvement in many patients.However, more than one injection treatment session is required toachieve satisfactory results. Furthermore, crosslinked collagen causeslocal tissue hypersensitivity due to the chemical used to crosslink thecollagen. There is a need for a bulking agent treatment that eliminatesmultiple injection sessions and does not cause tissue hypersensitivity.

SUMMARY OF THE INVENTION

The current invention is directed to a biologic delivery system thattreats prolapse, incontinence, and/or other urological disorders inmales and females. To eliminate serious problems associated withsystemic therapies, the delivery system provides for low dosages, andlocal and targeted delivery. Additionally, the delivery systemeliminates the need for repeated dosages to achieve optimal results. Thedelivery system generally comprises a biologic, including at least onebioactive agent.

The biologic can comprise any drug, drugs, or combination thereof totreat a specific pelvic disorder. The biologic can comprise crosslinkedbovine collagen. The crosslinked bovine collagen can strengthen walls oforgans to treat pelvic disorders. The biologic can comprise hormones orsteroids. For example, the biologic can comprise the ovarian steroid,estrogen, to treat vaginal prolapse. Ovarian steroids can increase thethickness of the vaginal tube. The biologic can comprise other bioactiveagents or growth factors. A bioactive agent can recruit cells and othergrowth factors to the treatment site to repair a body part in a naturalway. The biologic can also include but not be limited to porcine dermisand cadaveric tissue. The biologic can be a simple formulation and,therefore, easy and inexpensive to manufacture.

The biologic can be delivered locally to the desired location within thepelvic area in order to treat a pelvic disorder, e.g., via an injectionneedle. Further, the biologic can be provided with known implant orpelvic tissue support devices to facilitate local delivery whilemechanically supporting the structure(s) affected by the pelvicdisorder. The biologic is generally adapted to controllably release theagent over time. The biologic can degrade over time, allowing thedamaged tissues to remodel back into normal anatomical positions, inorder to prevent future recurrent prolapse.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 schematically illustrates relevant pelvic female anatomy.

FIG. 2 schematically illustrates relevant pelvic male anatomy.

FIG. 3 graphically illustrates cumulative release of b-FGF from aparticularized biologic at multiple loadings in accordance withembodiments of the present invention.

FIG. 4 graphically illustrates average percentage release of b-FGF froma particularized biologic in accordance with embodiments of the presentinvention.

FIG. 5 graphically illustrates average cumulative release of b-FGF froma particularized biologic in accordance with embodiments of the presentinvention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Embodiments of the present invention are directed to a delivery systemadapted to treat various urological disorders, such as prolapse,incontinence, and the like. The delivery system can include at least onebiologic loaded or otherwise provided with a bioactive agent.

FIGS. 1-2 schematically illustrate the relevant pelvic female and maleanatomy to demonstrate the potential organs or tissue that can betargeted (at or proximate) with the localized and targeted treatment ofthe present invention. Ligaments hold the bladder in place and connectit to the pelvic and other tissue.

As shown in FIG. 1, the female anatomy includes the urethra 1 and thebladder 2. The urethra 1 is a tube that passes urine from the bladder 2out of the body. The narrow, internal opening of the urethra 1 withinthe bladder 2 is the bladder neck 3. In this region, the bladder'sbundled muscular fibers transition into a sphincteric striated musclecalled the internal sphincter. The vagina 4 and anus 5 are furtherdepicted.

FIG. 2 illustrates the relevant male anatomy. The urethra 1 extends fromthe bladder neck 3 to the end of the penis 6. The male urethra iscomposed of three portions: the prostatic, bulbar and pendulousportions. The prostatic portion is the widest part of the tube, whichpasses through the prostate gland 7.

The biologic in accordance with embodiments of the present invention canbe any known material or device adapted to deliver an agent to thedesired location within the pelvic area to treat the aforementionedpelvic disorders. The biologic can comprise any drugs, hormones orsteroids, stem cells, growth factors, proteins, and/or other bioactiveagents known to those of ordinary skill in the art to recruit cells andpromote cell or tissue growth for the treatment and strengthening oforgan walls or tissue to treat pelvic disorders.

As such, the biologic is generally adapted to controllably release theagent to the surrounding tissue or organ to provide a local and targeteddelivery. The biologic can degrade over time, remodeling the damagedtissue back into its normal anatomical state or position to preventfuture problems or pelvic disorders.

In various embodiments, an injectable formulation of biologics can beinjected around the urethra or surrounding tissue to treat incontinenceand strengthen the urethral wall to prevent or treat incontinence. Forinstance, the delivering of proteins or growth factors to the urethra orits surrounding tissue can restore the function of the muscles aroundthe sphincter.

While various injectable formulations of biologics are envisioned foruse with the present invention, an injectable InteXen® solution can beemployed in various embodiments. InteXen®, or InteXen™, is anon-chemically crosslinked porcine dermis that can provide a relativelysoft, pliable biomaterial. Hydrated or non-hydrated InteXen® can beutilized. In this particular example, the InteXen® can be ground (e.g.,LN2 grinding) into particles to generate a paste-like injectablesolution. Various known grinding, sieving and like techniques can beemployed to obtain the desired consistency or particle size for theinjectable paste or solution. Further, various known needles (e.g., 20g-22 g needles), devices and techniques can be implemented to inject orotherwise deliver the solution into targeted tissue of the patient.Channelized or uniform distribution of the solution within the tissue ororgan of the patient may be better obtained if the solution is injectedduring needle withdrawal, thus avoiding solution accumulation orpooling. InteXen® is a biologic material (processed porcine dermis) thatis manufactured by American Medical Systems, Inc. and sold as a graftmaterial for surgical applications.

The injectable solution (e.g., InteXen®) can be loaded or otherwiseprovided with various drugs, hormones or steroids (e.g., estradiol),stem cells, growth factors and/or other bioactive agents. In oneembodiment, the solution can be loaded with a basic fibroblast growthfactor (b-FGF). Various saturations of particularized InteXen® withb-FGF can be employed as understood by those of ordinary skill in theart. FIGS. 3-5 depict ELISA data for the release of the b-FGF fromparticularized InteXen® at various loadings.

In addition to those materials and agents expressly described, variousand known biodegradable polymers, biologics, microspheres, gels,patches, proteins, steroids, porous materials, collagen, elastin, orbiopolymers can be utilized with embodiments of the present invention toobtain the desired delivery and localized treatment benefits of theexemplary embodiments of the present invention.

In various embodiments, the biologic can be incorporated or otherwiseprovided with various implants, slings (e.g., mesh or thin sheets), orlike devices to combine the benefits of the biologic formulation withdevices adapted to support prolapse tissues/organs or otherwise treatincontinence (including but not limited to urinary, fecal and flatalincontinence). Other applications include, levator avulsion and musclerepair as well as repair of damaged tissue from prostectomy procedures.For instance, InteXen® (particularized or non-particularized) loadedwith growth factors, steroids, stem cells or other agents can beincorporated with, coated or otherwise provided with known sling orimplant and repair systems (e.g., for male and female), features andmethods, including those disclosed in U.S. Pat. Nos. 7,500,945,7,407,480, 7,351,197, 7,347,812, 7,303,525, 7,025,063, 6,691,711,6,648,921, and 6,612,977, International Patent Publication Nos. WO2010/027796, WO 2008/057261 and WO 2007/097994, and U.S. PatentPublication Nos. 2002/151762 and 2002/147382. Accordingly, theabove-identified disclosures are fully incorporated herein by referencein their entirety.

All patents, patent applications, and publications cited herein arehereby incorporated by reference in their entirety as if individuallyincorporated, and include those references incorporated within theidentified patents, patent applications and publications.

Obviously, numerous modifications and variations of the presentinvention are possible in light of the teachings herein. It is thereforeto be understood that within the scope of the appended claims, theinvention may be practiced other than as specifically described herein.

What is claimed is:
 1. A biologic delivery system for treating pelvicdisorders in a patient, comprising: a biologic that is a particularizednon-chemically crosslinked porcine dermis loaded with a bioactive agentselected from the group consisting of a growth factor and a hormone; apelvic implant device adapted to support pelvic tissue of the patientand to deliver the loaded bioactive agent to a target tissue within thepelvic region of the patient, wherein the pelvic implant device is apelvic sling constructed at least in part of a mesh material or a thinsheet, and the biologic is incorporated into or coated on the pelvicsling.
 2. The system of claim 1, wherein the bioactive agent includes abasic fibroblast growth factor.
 3. The system of claim 1, wherein thebioactive agent includes a hormone.
 4. The system of claim 3, whereinthe hormone includes estrogen.
 5. The system of claim 1, wherein thebioactive includes a protein.
 6. The system of claim 1, wherein thepelvic implant device is a pelvic sling device constructed at least inpart of a mesh material.
 7. The system of claim 1 wherein the pelvicsling device is configured for the treatment of tissue or organprolapse.
 8. The system of claim 1 wherein the pelvic sling device isconfigured for the treatment of urinary incontinence.
 9. A method oftreating a pelvic disorder in a patient with a biologic delivery system,comprising: providing the pelvic implant device of claim 1 to a pelvicarea in a patient; and allowing the device to support pelvic tissue ofthe patient and to deliver the loaded bioactive agent to target tissueat the pelvic area of the patient to treat the pelvic disorder.
 10. Themethod of claim 9, wherein the bioactive agent includes a hormone. 11.The method of claim 9, wherein the bioactive agent includes a growthfactor.